Adoption
Why haven’t a larger percentage of consumers embraced DTC? Note: This is a rapidly changing environment as these services become more common from health plans and health providers and with the response to and demands of COVID 19.
As of the middle of 2019, nationwide consumer adoption of telehealth services has been stubbornly low, with less than 8% of healthcare consumers having used such services.(3). Although the potential is significant and growth is beginning to accelerate, there are a number of reasons that should be considered and understood:
- Resistance to change is a well-established tradition / mode of care – For well over 75 years, the standard method of accessing primary care is that you went to see a doctor. We are creatures of habit and for most consumers this has been a successful and comforting process. Consumer habits change slowly.
- Relationship with their physician – Many consumers have an established and trusted relationship with their physician. All of our examinations and discussions have been face-to-face and personal. A major political mantra in health insurance policy has been the ability for patients to keep the existing physician relationship. With the advent of EMRs and physicians in primary care, consumers are finding this is less and less true, but still effective. People and consumer habits change slowly.
- Perceived limitations in the capabilities of a DTC consult – To consumers, this may be perceived as “less medicine”. A common assumption can be that the provider capabilities must be less over a video call than in person. In reality most primary care conditions do not require an in-person visit. DTC has proven to be very effective in identifying issues that require an in-person assessment and advise the consumer/patient accordingly. J. D. Powers found that 84% of cases get resolved entirely on-line. Other reports (including DTC providers) raise this success rate to 95%. The rest of the encounters are referred appropriately.
- Concerned that they might have to pay twice – The concern that the DTC consult will direct them to an ER or other provider anyway resulting in additional changes to the consumer (pay twice). In some cases, this remains true, especially if the DTC providers do not have an existing relationship with the consumer’s network or alternative providers. This is being addressed in a variety of ways. Many DTC providers waive the charge if a satisfactory diagnosis cannot be reached and the patient must be referred to an in-person provider. Health Networks and employer plans have integrated their in-person and DTC services so that the DTC charge is applied to the in-person visit if needed (just as an Urgent Care Center charge is usually either waived or credited if a consumer is referred to an ED).
- Price/Value – One big mistake DTC programs have made is to price the DTC at the same or more than a standard primary care co-pay. Since the consumer perception is for a lower cost and slightly riskier spend, the price should be the same or less which is justified because the cost of a DTC consult is less and may be more valuable to the provider
Accelerating Growth
DTC has shown rapid growth over the past ten years. Much of this growth can be attributed to:
- DTC services are being more widely offered. Most health plans, employer health plans, health systems and payers offer these services to their employees/customers.
- Gradual consumer acceptance – High satisfaction rate. “… among those early adopters who are using telehealth, customer satisfaction with the experience ranks among the highest of any consumer category studied by J.D. Power.”(3)
- Impact of the COVID 19 – The infection risk of COVID 19 and resulting stay at home orders have discouraged consumers from going to in-person care environments to avoid being infected or infecting others. In addition, providers have implemented limitations to in-person visits to reduce risk of infecting themselves or their patients. This has not stopped the consumer’s need for care or the need for providers to provide follow-up visits and alternatives to office visits for their patients in order to sustain their practices. The CMS and HIPAA waiver of certain restrictions have encouraged providers to provide visits and follow-up with their patients. Healthcare plans have also implemented video health assessments. This has rapidly exposed both more consumers and more providers with the experience of a video and phone consultation. In December 2019, less that 8% of patients had ever been exposed to telemedicine. By the end of May 2020, that had grown rapidly to approximately 30% and continues to grow rapidly as the pandemic continues. This may have a profound impact on the acceptance of and use of DTC telemedicine services.